Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement

Key Points Question What is the estimated risk of revision for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) using antibiotic-loaded bone cement (ALBC) vs plain bone cement? Findings This cohort study of 2 168 924 cemented primary TKAs for osteoarthritis between 2010 and 2020 found no difference in risk of revision for PJI in TKAs with plain bone cement compared with TKAs with ALBC at 1 year. Meaning These findings suggest that the routine use of ALBC in primary TKA should be considered in the context of the overall health care delivery system.

FAR & PABZ had reported no revision due to infection following primary TKAs with plain bone cement.NAR reported 100% use of ALBC in primary TKAs.AOANJRR = The Australian Orthopaedic Association National Joint Replacement Registry DKR = The Danish Knee Arthroplasty Registry EPRD = The German Arthroplasty Registry  Favours plain bone Favours ALBC cement eFigure 5: Meta-analysis on risk of revision due to PJI following primary TKA with ALBC vs plain bone cement.The meta-analysis was based on result from Cox-regression analysis adjusted for age, sex, year of surgery [time period], and all other variables available in each participating registry.a a The size of the square in the forest plot corresponds to each registry weighted based on the number of TKA with plain bone cement in the registry.eFigure 6: Meta-analysis on risk of revision due to all-causes following primary TKA with ALBC vs plain bone cement.The meta-analysis was on result from unadjusted Cox-regression analysis.a

Favours plain bone cement
Favours ALBC a The size of the square in the forest plot corresponds to each registry weighted based on the number of TKA with plain bone cement in the registry.

Favours plain bone cement
Favours ALBC eFigure 7: Meta-analysis on risk of revision due to all-causes following primary TKA with ALBC vs plain bone cement.The meta-analysis was based on result from Cox-regression analysis adjusted for sex, and year of surgery [time period].a a The size of the square in the forest plot corresponds to each registry weighted based on the number of TKA with plain bone cement in the registry.eFigure 8: Meta-analysis on risk of revision due to all-causes following primary TKA with ALBC vs plain bone cement.The meta-analysis was based on result from Cox-regression analysis adjusted for age, sex, year of surgery [time period], and all other variables available in each participating registry.a

eFigure 1 :
Cumulative percent revision (one minus Kaplan-Meier estimator) due to PJI following primary TKA with (a) ALBC vs (b) plain bone cement., and PATN had reported no revision due to infection following primary TKA with plain bone cement.NAR reported 100% use of ALBC in primary TKA.Cumulative percent revision Cumulative percent revision \ © 2024 Leta TH et al.JAMA Network Open.

eFigure 2 :
Cumulative percent revision (one minus Kaplan-Meier estimator) due to all-causes following primary TKA with (a) ALBC vs (b) plain bone cement.
provincial register of knee prostheses-(Autonomous Province of Bolzano-Italy) PATN = The Trento provincial register of knee prostheses-(Autonomous Province of Trento-Meta-analysis on risk of revision due to PJI following primary TKA with ALBC vs plain bone cement.The meta-analysis was based on results from unadjusted Cox-regression analysis.aFavours plain bone cementFavours ALBC a The size of the square in the forest plot corresponds to each registries weighted based on the number of TKA with plain bone cement in the registry.
Meta-analysis on risk of revision due to PJI following primary TKA with ALBC vs plain bone cement.The meta-analysis was based on the results from Cox-regression analysis adjusted for age, sex, year of surgery [time period].a a The size of the square in the forest plot corresponds to each registries weighted based on the number of TKA with plain bone cement in the registry.

eTable 1: The
Cox regression results from individual registries of revision for PJI following primary TKA with ALBC vs. plain bone cement (2010-2020).
= Swiss National Implant Register © 2024 Leta TH et al.JAMA Network Open.eTable 2: Sensitivity analysis of the meta-analyses (Cox-model 2) of revision for PJI and all-causes to determine how sensitive the meta-analyses results are to the results of individual registry contributions.One at a time, one registry was excluded from the meta-analysis to see if it changes in the statistical significance.Sensitivity analysis of meta-analyses (Cox-model 3) of revision for PJI and all-causes to determine how sensitive the meta-analyses results are to the results of individual registry contributions.One at a time, one registry was excluded from the meta-analysis to see if it changes in the statistical significance.
a a